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I am concerned for my 4-1/2 year old grandson who I believe to have roundworms (ascaris lumbricoides). We found one in the toilet bowl after he had used it but it was flushed away before I could obtain the evidence. I sent a 3 day stool test to Great Smokies for parasitology which came back negative. (I have read since that false negatives are not uncommon). It showed some occult blood (and recommended further investigation) which I personally believe to be abnormal in a four year old. This child is underweight (looks more like a two or three year old), with dark circles under eyes and a morning cough for over two years. He has a huge appetite and produces a lot of unpleasant gas. He sometimes has slight pruritis on the trunk but no anal itching or pinworms and occasionally vomits and has tummy aches. I do not live with him and have not been able to examine vomit or stool. His mother does not believe he has anything wrong and also is not open to the use of any medication. She does not accept that occult blood is unusual in a child. She has no problem with my giving him vitamin supplements which he takes very well. Please let me know how you would approach this? Would you do a further test?

The first principle of medicine, after do no harm, is first diagnosis, and only then treatment. Persistent occult blood in the stool is not a normal finding in an adult or a child, nor is persistent gas production unrelated to specific foods a normal finding at any age. One should not rest until the cause of these findings is discovered. There are conditions other than parasites which can cause these findings. I could list them, but I do not want to give false alarms. The important thing here is to get this child to a doctor who can make the diagnosis and institute proper treatment. Perhaps a specialist in internal medicine with a sub-specialty in infectious disease would be the best choice. It appears that you are describing a case of what is called "failure to thrive." Unless the cause of failure to thrive is discovered and corrected there can be long-lasting consequences. Many conditions children "just get over," but not all. If one is going to err, it is very important to err on the side of caution.